ESPE Abstracts

Background: Type 1 diabetes (T1D) is characterized by chronic hyperglycemia and microvascular complications like retinopathy, nephropathy, and neuropathy in long term. Nailfold video capillaroscopy (NVC) is a non-invasive method used to examine the microcirculation in the skin. In this study, we aimed to evaluate the microvascular structure in T1D with NVC, observe capillaroscopic alterations, and reveal the relationship of capillaroscopic abnormalities with glycemic control.

Methods: In this cross-sectional study, 40 patients (F/M:19/21) followed for at least 6 months with the diagnosis of T1D and 40 age- and sex-matched healthy controls were included. Demographic data, clinical findings, and laboratory characteristics of the patients were obtained from the patient files. All patients underwent NVC to evaluate morphological and structural changes in the vessels, and findings were compared with healthy peers. Except for the thumbs, all fingers were examined four times from each finger, with a total of 32 images taken from each child.

Results: The median age of the diabetic group was 16.5 (IQR: 11.1-18) years, and the median age of the healthy controls was 15 (IQR: 12-17) years, and the control and patient groups were similar in terms of age and gender (P>0.05). The median diabetes duration of the patients was 75 (IQR: 34.5-125) months, and the mean insulin dose was 0.97±0.3 U/kg/day. On physical examination, mean weight SDS was -0.5±1.3; height SDS was -0.4±1.1; and BMI SDS was -0.4±1.3. Fifteen percent of the patients (n=6) was prepubertal. The mean HbA1c value of the last 1 year was 8.9±1.9%. Microalbuminuria, retinopathy, and neuropathy was present in 33.3% (n=13), 7.5% (n=3), and 5% (n=2) of the patients, respectively. When capillary morphology was evaluated, frequency of major abnormalities was higher (P<0.001) in children with T1D compared to healthy controls. Children with T1D showed significantly more capillary cross (P<0.001), enlarged capillary (P<0.001), bushy capillary (P=0.03), bizarre capillary (P<0.001), microhemorrhage (P=0.007), and neoangiogenesis (P<0.001). In addition, capillary density (P=0.01) was significantly lower in the patient group while intercapillary distance (P<0.001) was significantly longer compared with healthy volunteers. Lower capillary density and wider capillary loops were associated with higher HbA1c values (r:-0.32, P=0.04; r:-0.35, P=0.02).

Conclusion: Besides significant capillaroscopic alterations, a pattern of enlarged capillaries and low density in patients with poor glycemic control were detected, thus NVC appears to be a simple and non-invasive tool for assessing early microvascular involvement in T1D.